Upstate’s acquisition of Community General Hospital last year is but one example of the consolidations, mergers and affiliations among health care providers taking place in “almost every corner of the state,” Upstate University Hospital CEO John McCabe MD told a gathering of the Thursday Morning Roundtable this morning.

McCabe addressed the weekly civic forum, outlining ways in which health care is changing throughout Central New York, regardless of what happens with health care reform.

1. Hospitals are exploring mergers and affiliations to reduce costs and better manage populations of patients. McCabe said some hospitals in the region are “on the brink” and others are on their way to being in serious financial trouble.

2. Doctors in private practice are providing more office-based care and expect compensation when they provide hospital care. They are also expanding their practices to surgical centers and diagnostic centers, services that hospitals used to rely on for income. McCabe also said that a growing number of physicians are opting to be employed, rather than starting their own practices.

3. Health care services are being marketed to wider geographic areas, and the competition among health care providers is climbing. “Four out of five billboards on Interstate 690 are for somebody advertising medical services,” he quipped.

When asked about the potential for mandated health insurance, McCabe explained what impact such a law might have in New York, which is generous in its Medicaid coverage. Nationally, 16 percent to 18 percent of the population is uninsured. Among patients at Upstate, the rate is 6 to 8 percent. As more of the overall population becomes insured, however, Upstate will receive less money in disproportionate share hospital (DSH) payments from the federal government for taking care of the poor.

Upstate serves a region of Central New York that stretches from the Canadian border to Pennsylvania. The majority of its $1.3 billion operating budget comes from providing clinical services, with a small percentage coming from New York State.

McCabe explained that Upstate cares for patients that other hospitals do not. Upstate has specialists in neurological intensive care and transplant surgery, for instance, who are not available elsewhere in the area. Upstate also provides “safety net” services including the burn unit, hyperbaric oxygen therapy and bone marrow transplants. More unique services will be available in the new Upstate Cancer Center, which is under construction in front of the hospital at 750 East Adams St.

Adding the Community General campus last summer has allowed Upstate to spread patients across two campuses and expand services. An overnight epilepsy monitoring unit opened in October. The region’s first After Hours Care specifically for children opened last month. The bariatrics program will relocate there, and McCabe said other services will too. “It’s still a work in progress,” he said. “So far, it’s been pretty successful.”

Also still in the works is an interest in Van Duyn Home and Hospital, a skilled nursing facility run by Onondaga County. Upstate would like to turn it into a geriatric center of excellence with space for patients who are ready to be discharged from the hospital but who have special needs such as wound care or ventilator assistance. McCabe said that plan is on hold, waiting for SUNY officials in Albany to determine its viability.